Effect of the quality of health care on permanent inability secondary to femoral fractures due to occupational accidents

Objective. To construct and validate an indicator for evaluating the quality of care for femoral fractures, and to assess the contribution of the quality of health care as a determinant of partial permanent inability secondary to femoral fractures due to occupational accidents. Materials and methods. The study was conducted from January to December 1995 at Mexican Institute of Social Security. The instrument was designed with experts' contribution along different stages and validated using implicit criteria and factorial analysis. A case-control study was then conducted to evaluate the contribution of the quality of care to inability secondary to femoral fractures. Cases were 108 active workers with permanent inability secondary to femoral fracture; controls were 94 active workers with fractu-re of femur but no permanent inability. Logistic regression modeling was used to establish the association between quality of care and partial permanent inability, adjusting by relevant variables. Results. The ultimate indicator of quality of care consisted of the following: Timely care, pre-surgical management, surgical management, and fracture complications. A final score over 229 points meant that the worker had received good quality of care. Workers getting 229 or less points had received poor quality of care. Forty-eight (44 por ciento) cases and 66 (70 por ciento) controls received good quality of medical care. The likelihood of partial permanent inability was almost three times higher among workers given poor quality of care (OR 2.95; 95 por ciento CI 1.5 - 5.5). According to the multivariate model, predictors of partial permanent inability were: Having exposed or epiphysiary fractures, being re-submitted to surgery, having less than 90 days of rehabilitation care, and receiving deficient medical care. Conclusions. The constructed instrument was validated. The level of the quality of care received by workers is a determining factor for the generation of partial permanent inability. In workers having femoral fractures, it is important to consider timely medical care and early rehabilitation, to reduce the high incidence and prevalence of this medical problem in Mexico. The English version of this paper is available too at: http://www.insp.mx/salud/index.html

Esguince lumbar en la industria química / Lumbar sprain in the chemical industry

Objetivo: identificar y comparar el comportamiento del esguince lumbar por accidente de trabajo en los trabajadores de la industria química y en el resto de actividades económicas. Se revisaron 97.843 casos durante 1995-1997. Se analizó: tipo de riesgo, edad, sexo, ocupación, antigüedad laboral, incapacidad temporal y permanente (IPP), causa externa, acto inseguro. El tiempo de resolución promedio por caso fue de 21 a 24 días y la tasa de incapacidad permanente parcial disminuyó de 7,2 a 5,1/1.000 esguinces lumbares de trabajo respectivamente. Hay diferencias significativas en la incidencia de casos de estas poblaciones p<0,001; así como entre los días de incapacidad por caso en los años de 1995 p<0,001; 1996 p<0,001 y 1997 p<0,001. Al analizar el puesto de ayudante general contra otros puestos de trabajo se encontraron diferencias con un RR de 2,1 (p<0,001). Los trabajadores que realizan esfuerzos físicos y movimientos vigorosos contra los que no lo realizan de las poblaciones estudiadas presentan un RR de 2,03 (p<0,001). Se concluye que las medidas preventivas y de manejo médico que se han establecido en ambas poblaciones en el período 95-97, no han generado disminución significativa de la incidencia, tiempo de evolución e incapacidad permanente parcial de este problema de salud